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Öğe A Case of Oxcarbazepine-Induced Severe Hyponatremia(Kare Publ, 2011) Degirmenci, Yildiz; Yilmaz, Yeliz; Ors, Ceyda Hayretdag; Karaman, Handan Isin OzisikOxcarbazepine is a keto-analogue of carbamazepine. Hyponatremia seen in the patients treated with oxcarbazepine is usually asymptomatic and rarely severe which leads to drug withdrawal. Here we presented a 51-year old female patient with epilepsy under oxcarbazepine and valproate treatment, who presented to our outpatient neurology clinic with vertigo, nausea and vomitting after the usage of her antiepileptic drugs. Routine biochemistry evluations revealed a decresed serum sodium level with increased urine sodium and osmolarity levels. Renal ultrasonography was normal. The patient was pre-diagnosed as inappropriate antidiuretic hormone secretion syndrome. Three days after the oxcarbazepine withdrawal, serum and urine sodium levels were found to be normal.Öğe A Case of Psychogenic Movement Disorders: Dark Side of Neurology and Neuropsychiatry(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2012) Degirmenci, Yildiz; Oyekcin, Demet Gulec; Karaman, Handan Isin OzisikOur aim was to describe a patient with psychogenic movement disorder (PMD) who presented with tremor dominant involuntary movements, as well as to emphasize the clinical features important for establishing a correct diagnosis. A 48-year-old man presented to our outpatient neurology clinic with gait and speech disturbance. He had jerky, tremor-like involuntary movements occurring during gait, voluntary movements and/or at rest. The involuntary movements of the patient, who benefited from risperidone treatment and supportive interviews, substantially disappeared. Since PMDs are complex disorders, a multidisciplinary approach with cooperation of neurologistand psychiatrist is needed for proper diagnoses and treatment. (Archives of Neuropsychiatry 2012; 49: 235-237)Öğe Anxiety and depression in primary and secondary dystonia: A burden on health related quality of life(2013) Degirmenci, Yildiz; Oyekcin, Demet Gülec; Bakar, Coskun; Kurklu, NehirDystonia is a reason of visible chronic motor and/or psychological disability that may influence the quality of life. Our aim was to investigate depression and anxiety in patients with primary and secondary dystonia, and to evaluate their effects on the quality of life. Patients with primary and secondary dystonia, and age-matched healthy volunteers were enrolled in the study. Anxiety and depression was evaluated with Hospital Anxiety Depression (HAD) scale. Short Form-36 was used to assess the quality of life in both study groups. Both mean anxiety and depression subscales scores were found to be increased in the patients with dystonia, when compared with the control group (p < 0.05). There were no statistically significant differences in the HAD scores patients with primary and secondary dystonia (p > 0.05). When compared with controls, all domains of SF-36 were found to be decreased in patients with dystonia contributing to a deterioration in the HR-QoL (p < 0.05). Among dystonia patients, a statistically significant decrease was found in all domains of SF-36, except vitality and mental health in secondary dystonia (p < 0.05). Multiple regression analysis revealed that secondary dystonia, long term disease, depression and anxiety have a great impact on quality of life of patients with dystonia. Dystonia can be considered as an important risk factor for anxiety and depression which leads to a deterioration in the quality of life of patients. © 2013 Elsevier GmbH.Öğe Divalproex Sodium and Topiramate for Migraine ProphylaxisMigren(Derman Medical Publ, 2012) Degirmenci, Yildiz; Karagoz, Erkan Taner; Karaman, Handan Isin OzisikAim: To compare the efficacy, safety of topiramate and extended-release divalproex sodium in migraine prophylaxis. Material and Method: Study groups consisted of 22 patients with chronic migraine, randomly administered 1000mg extended-release divalproex sodium (first group), 21 patients given 100mg topiramate (second group).Study was 28-week randomized, prospectivetrial including 4-week baseline, 4-week titration, 20-week maintenancephase.Primary efficacy measure was reduction from baseline in 4-weekmigraine frequency.Secondary efficacy measures included responder rates,mean reduction in migraine duration,severity.Severity of headache wasquantified by using 10-point visual analogue scale (VAS). Responder rateswere defined as percentage of patients who demonstrated = 50%. reductionin migraine frequency per month. Results: Reduction from baseline migrainefrequency at the end of six month was primary outcome measure.Meanmigraine frequency at the end of study was 1.27 +/- 1 (baseline; mean +/- SD:3.6 +/- 2) in the first, 1.2 +/- 1.2 (baseline; mean +/- SD: 3.5 +/- 2.3) (p<0.0001) inthe second gr nt in frequency was observed in 16 patients (72.7%) in the first group, and 16 patients (76.2%) in the second group.Only a limited number of patients were excluded from the study due to side effects as 2 patients from the first group and 1 patient from the second group.The most common side effect was weight gain in the first and paresthesia in the second group. Discussion: Both divalproex sodium, topiramate were almost equally effective in reducing migraine frequency, duration, severity.Total relief from migraine attacks were more in topiramate than extended-release divalproex sodium.Öğe Effects of Pain and Disability on Quality of Life in Patients with Carpal Tunnel Syndrome(Duzce Univ, 2013) Ozturk, Ayhan; Degirmenci, Yildiz; Kececi, Hulusi; Zateri, Coskun; Altan, Mehmet; Ankarali, HandanObjective: To evaluate the association between severity of carpal tunnel syndrome (CTS), pain, disability and to assess their effects on quality of life. Methods: CTS patients whose diagnosis were confirmed with nerve conduction studies were classified as mild, moderate, and severe. Pain evaluation was performed by Pain Quality Assessment Scale (PQAS) in all patients. Short form-36 (SF-36) was used to assess quality of life and Brief Disability Scale was used in the evaluation of disability. Results: 93.1% of the patients were women, and 6.9% were men. Mean age was 44.20 +/- 8.76 years (range=29-62). Mean duration of symptoms was 6.67 +/- 3.00 months (range=3-12 months). Most common symptom was paresthesia. Electrophysiological evaluations revealed moderate CTS in 43.8%, mild CTS in 44.8%, severe CTS in 6.9% of the patients. There was no significant association between CTS severity and time course subgroup of PQAS (p=0.222). But there was a statistically significant difference in the general pain subgroup and total scores of PQAS between moderate and severe CTS patients (p<0.05). There was a statistically significant difference in the mean scores of Brief Disability Questionnaire between patients with mild and severe CTS (4,46 +/- 3,61 and 11,50 +/- 4,94, p<0.05, respectively). A statistically significant negative correlation was found between the level of disability and physical function, pain, vitality, social function and mental health domains of SF-36. Conclusion: Quality of life is variably affected in patients with CTS due to the severity of CTS. On this aspect, it is important to diagnose and treat CTS on time to improve the quality of life of patients with CTS in early period, which is the best known and common compression neuropathy of upper extremity in community.Öğe Epidural Abscess Due to a Mycobacterium tuberculosis Strain with Primary Resistance to Isoniazid and Ethambutol(Ankara Microbiology Soc, 2012) Sener, Alper; Alper Akçalı; Karatag, Ozan; Kosar, Sule; Degirmenci, Yildiz; Akman, TarikTuberculosis is primarily characterized by pulmonary involvement, however, one third of the cases exhibit extrapulmonary tuberculosis. In this report, a case of epidural abscess due to Mycobacterium tuberculosis with primary resistance to isoniazid and ethambutol was presented. A 57-year-old male patient was admitted to emergency service with ten days history of weakness in legs, disability of walking and fever. Neurological examination revealed paraplegia of lower extremities, numbness distal to T2 disc level and hyperactivity of deep tendon reflexes indicating transverse myelitis. Laboratory findings were as follows; ESR: 74 mm/hour, CRP: 22 g/L, ALT: 42 IU/L, AST: 45 IU/L and white blood cell count 23.000/mm(3) (45% polymorphonuclear leukocyte, 45% lymphocyte, 10% monocyte). Spinal magnetic resonance imaging showed a fusiform abscess localized at anterior epidural space and extending along levels of C5-6 and C6-7. The longitudinal dimension of the abscess was 3 cm. The lesion was hypoin-tense on T1 and hyperintense on T2 weighted MRI images with prominent rim shaped contrast enhancement on contrast-enhanced T1-weighted images. At fourth day of hospitalization the patient underwent neurosurgical management. M.tuberculosis was isolated from the cultures of operation material by Mycobacteria Growth Incubator Tube system (MGIT, BBL; BD, USA) on the 12th day. The isolate was found susceptible to streptomycin and rifampisin, but resistant to isoniazid and ethambutol. The treatment was initiated with rifampicin 600 mg/day, pyrazinamid 2 g/day, ethambutol 1.5 g/day and levofloxacin 500 mg/day. At the end of second month levofloxacin 500 mg/day and rifampisin 600 mg/day combination was sustained and total treatment period was planned as nine months. As far as the national literature was considered, this was the first case of extrapulmonary tuberculosis with primary resistance to isoniazid and ethambutol.Öğe Isolated lingual dystonia induced by speaking: a rare form of focal dystonia(Acta Medica Belgica, 2011) Degirmenci, Yildiz; Ors, Ceyda Hayretdag; Yilmaz, Yeliz; Karaman, Handan Isin OzisikFocal lingual dystonia is a rare condition that can be misdiagnosed as a psychogenic problem because it may interfere with chewing, swallowing, and speaking. We present a patient with an uncommon type of dystonia (speech-induced primary lingual dystonia), that responded well to botulinum toxin injection.Öğe Lightning strike: a first case of unilateral diaphragmatic paralysis(Pagepress Publ, 2011) Alar, Timucin; Degirmenci, Yildiz; Karaman, Handan Isin OzisikLightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally.Öğe Melkersson-Rosenthal Syndrome in a Patient with Systemic Lupus Erythematosus: A Rare Comorbidity(Turkish League Against Rheumatism, 2012) Degirmenci, Yildiz; Kobak, Senol; Ors, Ceyda Hayretdag; Karaman, Handan OzisikMelkersson-Rosenthal syndrome (MRS) is a rare granulomatous disease characterized by recurrent orofacial edema, facial palsy, and a fissured tongue. In this article, we report a 23-year-old female case with recurrent peripheral facial palsy, mild orofacial edema, and a fissured tongue. She had spots in her feet with a history of oral aphthous ulcers and experienced a relapse once a year. The neuroimaging results were normal, however the laboratory examination indicated systemic lupus erythematosus (SLE). This rare case is presented to emphasize the complete triad of MRS concomitantly occurring with SLE in this patient.Öğe Perception of epilepsy in Turkey in the light of two different cities(2013) Degirmenci, Yildiz; Kabay, Sibel Canbaz; Yilmaz, Zahide; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the perception of epilepsy in Turkey, from west to east, in Kutahya and Yuksekova, two cities of different sociocultural and ethnic status. This was a retrospective comparison study which evaluated the results of two prior studies investigating stigmatization of patients diagnosed with epilepsy and their first-degree relatives in two different cities of Turkey, Kutahya and Yuksekova. The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions on descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data collected by use of the SPSS 15.0 software were analyzed with ?2-test. In Yuksekova group, 88.5% of first-degree relatives of people with epilepsy felt primarily fear when they heard the diagnosis of epilepsy in their relatives; in Kutahya group, the respective rate was 19.1% (p<0.05). The number of participants who objected their child marrying someone with epilepsy was significantly higher in Yuksekova group (p<0.05); however, if married, the Yuksekova group significantly stated that they should have a baby, revealing the importance of children as an indicator of power and dignity in the eastern region of Turkey (p<0.05). Although understanding of epilepsy was favorable, educating the community about epilepsy and personal contacts are the major strategies against epileptic stigmatization.Öğe PERCEPTION OF EPILEPSY IN TURKEY IN THE LIGHT OF TWO DIFFERENT CITIES(Sestre Milosrdnice Univ Hospital, 2013) Degirmenci, Yildiz; Kabay, Sibel Canbaz; Yilmaz, Zahide; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the perception of epilepsy in Turkey, from west to east, in Kutahya and Yuksekova, two cities of different sociocultural and ethnic status. This was a retrospective comparison study which evaluated the results of two prior studies investigating stigmatization of patients diagnosed with epilepsy and their first-degree relatives in two different cities of Turkey, Kutahya and Yuksekova. The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions on descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data collected by use of the SPSS 15.0 software were analyzed with chi(2)-test. In Yuksekova group, 88.5% of first-degree relatives of people with epilepsy felt primarily fear when they heard the diagnosis of epilepsy in their relatives; in Kutahya group, the respective rate was 19.1% (p<0.05). The number of participants who objected their child marrying someone with epilepsy was significantly higher in Yuksekova group (p<0.05); however, if married, the Yuksekova group significantly stated that they should have a baby, revealing the importance of children as an indicator of power and dignity in the eastern region of Turkey (p<0.05). Although understanding of epilepsy was favorable, educating the community about epilepsy and personal contacts are the major strategies against epileptic stigmatization.Öğe Perceptions of epilepsy of three different groups in Turkey(Academic Press Inc Elsevier Science, 2010) Degirmenci, Yildiz; Karaman, Handan Isin Ozisik; Bakar, CoskunObjective: Our aim was to investigate epilepsy-related knowledge, behavior, perceptions, and attitudes of people with epilepsy, their relatives, and a control group (390 participants in total) at the State Hospital Neurology Clinic, Yuksekova City, Turkey. Methods: The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions about descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data on SPSS 15.0 software were analyzed with the chi(2) test. Results: Patients (95.3%), their relatives (89.2%), and controls (63.3%) felt primarily fear when they heard the diagnosis of epilepsy. Most participants would not let their child marry a person with epilepsy, with no statistically significant difference between groups (P>0.05). Patients (66.7%) and relatives (70%) saw no problem in people with epilepsy having children; there was a statistically significant difference between groups on this point because of the control group's response (31.5%) (P<0.05). Conclusion: Patients and relatives showed similar attitudes and behaviors, perhaps because they had common information and experience regarding the disorder. (C) 2010 Elsevier Inc. All rights reserved.Öğe The prevalance of epilepsy among college students in Canakkale, Turkey(Klinicka Bolnica Sestre Milosrdnice, 2015) Ozkan, Adile; Degirmenci, Yildiz; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the frequency of epilepsy among students of the Canakkale Onsekiz Mart University. This cross sectional epidemiological study was performed on 4762 of 19,988 Canakkale Onsekiz Mart University students in the academic year 2007-2008. Participants that answered "epilepsy" to the question "Do you have any disease diagnosed by a doctor?" in a questionnaire including 4 subgroups were identified. Data were transferred to the Epi-Info Version 6.0 statistics program and controlled data were analyzed in the SPSS 15.0 statistics program. There were 53.1% of female and 46.9% of male students, mean age 20.4±2.1 (range 17-43) years. Twelve (0.25%) students had epilepsy diagnosis, eight (66.7%) female and four (33.3%) male, mean age 20.8±1.8 years. In our study, epilepsy was detected in 0.25% of students (n=12). Age specific prevalence studies related to epilepsy epidemiology are extremely rare, especially in university students with average intelligence. Thus, we considered that it would be epidemiologically significant to share the results of our cross sectional study with all those involved in epilepsy epidemiology and management.Öğe THE PREVALANCE OF EPILEPSY AMONG COLLEGE STUDENTS IN CANAKKALE, TURKEY(Sestre Milosrdnice Univ Hospital, 2015) Ozkan, Adile; Degirmenci, Yildiz; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the frequency of epilepsy among students of the Canakkale Onsekiz Mart University. This cross sectional epidemiological study was performed on 4762 of 19,988 Canakkale Onsekiz Mart University students in the academic year 2007-2008. Participants that answered epilepsy to the question Do you have any disease diagnosed by a doctor? in a questionnaire including 4 subgroups were identified. Data were transferred to the Epi-Info Version 6.0 statistics program and controlled data were analyzed in the SPSS 15.0 statistics program. There were 53.1% of female and 46.9% of male students, mean age 20.4 +/- 2.1 (range 17-43) years. Twelve (0.25%) students had epilepsy diagnosis, eight (66.7%) female and four (33.3%) male, mean age 20.8 +/- 1.8 years. In our study, epilepsy was detected in 0.25% of students (n=12). Age specific prevalence studies related to epilepsy epidemiology are extremely rare, especially in university students with average intelligence. Thus, we considered that it would be epidemiologically significant to share the results of our cross sectional study with all those involved in epilepsy epidemiology and management.Öğe Tumour necrosis factor alpha, interleukin 10 and interleukin 6 gene polymorphisms of ischemic stroke patients in south Marmara region of Turkey(E-Century Publishing Corp, 2015) Ozkan, Adile; Sılan, Fatma; Uludağ, Ahmet; Degirmenci, Yildiz; Karaman, Handan Isin OzisikBackground: Stroke is an important cause of adult mortality and morbidity; however its pathogenesis is still unknown. Several studies have examined to determine the role of genetic polymorphism of proinflammatory cytokines in the occurence of stroke. The objective of this study was to evaluate the relationship between three polymorphisms; including tumour necrosis alpha (TNF alpha)-238 GA, interleukin(IL-10)-1028 GA (rs1800896), IL-6-(rs1800795) and ischemic stroke in a Turkish population. Methods: Forty two stroke patients and 48 healhty controls were genotyped using PCR analysis for TNF alpha-238 G/A, IL-10-1028 GA and IL-6-rs1800795 AG polymorphisms. Results: The frequency of the CC and CG, GG genotype of IL-6 gene (rs1800795) were statiscially significiantly higher in IS patients than controls (for C/C genotype, P=0.03, OR=4.3; 95% CI: 1.13 to 16.29 and for C/G genotype, P=0.04, OR=3.6; 95% CI: 1.03 to 12.95, for G/G genotype, P=0.02, OR=0.25; 95% CI: 0.07-0.85 respectively). Conclusion: IL-6 CC genotyped was found strongly associated with ischemic stroke than other two polymorpisms TNF-alpha and IL-10 in our population.
